Thursday morning began much like any other at Stormont Vail Hospital in Topeka: doctors and administrators, most of whom have already been up for hours, shuffle into a meeting room, clutching coffee mugs.
What comes next resembles a high-stakes game of Whack-a-Mole, as team members are briefed as to the current COVID-19 situation in the facility, crunching numbers and putting out fires.
Positive news and potential pitfalls come in equal measure, as up-to-the-minute capacity information, equipment shortages and staffing levels are all discussed.
The effects of a recent surge of cases at Stormont Vail have been well-documented: beds moved into hallways and waiting rooms, staff members working extra shifts and patients being held in the emergency room to wait for in-patient beds to become available, sometimes overnight.
The question for hospital staff becomes what comes next, with the Thanksgiving holiday approaching all too rapidly and case counts showing no signs of slowing down.
"The real challenge is every day, sometimes hour to hour, making the adjustments, bringing the resources to bear, so that we can continue to provide the full spectrum of care," said Kevin Dishman, chief medical officer at Stormont Vail. "So that's a huge job."
Capacity issues worsen statewide
It isn’t just Stormont Vail.
Across Kansas, 44% of hospitals say they are reporting staffing shortages this week due to COVID-19, according to data reported by the Kansas Hospital Association. That’s up from roughly a third of facilities having similar issues as recently as last week.
Statewide, 16% of in-patient beds are staffed and available, according to the KHA, although that varies by region.
In southwest Kansas, only 5% of beds are free, whereas in the north-central part of the state, a third of capacity remains open.
In Salina, the number of COVID-19 patients has more than doubled in the past week alone and most of those are now coming from within the community, whereas before patients originated from across the state.
Robert Freelove, chief medical officer at Salina Regional Medical Center, said the facility has been taking steps to cope, although he acknowledged most of them would only work in the short term.
"To be completely honest, everything we’re doing right now is trying to put a finger in the hole of a dam," Freelove said. "There are things you can do that will help in the shorter term and the hope is that we get can get through the next two to three weeks, or probably two to three months."
How to counter the challenges hospitals are facing is a question with few easy answers.
State, hospitals reach for staffing solutions
Officials are skeptical of the idea of erecting temporary bed space or field hospitals, although Shawnee County officials confirmed Thursday they were at least exploring the idea of moving beds into Stormont Vail Events Center if the situation worsens.
But this would not solve the broader personnel issues.
"You could build all sorts of construction and not necessarily solve the staffing problem," Lee Norman, secretary of health and environment, said last week. "At this point in time, beds are tight, but it is really staffing that we are most concerned about."
Freelove said Salina was attempting to make contact with firms about using traveling nurses and medical providers, although this has been complicated by the fact that most every state is encountering similar staffing issues.
Typically, a traveling nurse would be paid one-and-a-half to two times as much as a staff nurse, but as demand has risen dramatically, so has their cost. A hospital might now need to pay five times as much as they would normally in order to get outside help.
Freelove said his facility was looking to partner with other hospitals in the region to find state or federal funding to offset the costs, although he noted that this would not be a silver bullet.
"You can’t just go out and ask a person who is walking by on the street ’Hey can you help us be a nurse for four patients," he said. "It is a real dilemma."
There are other potential contingency plans, as well. The state has a Medical Reserve Corps, or a group of units composed of volunteer medical and public health staff, which could theoretically be mobilized in the event of a crisis.
Other states have used their corps members to help ensure the safe operation of polling places during the Nov. 3 election or to operate mass testing sites and set up field hospitals.
But there are hurdles to overcome if Kansas were to attempt to use them on a mass scale in hospitals, Norman said, including licensing.
And the eight units are housed at the county or regional level, meaning the involvement of multiple jurisdictions would likely be necessary.
An official with the Reno County Health Department, for instance, said they would need approval from the county commission before mobilizing their reserve corps.
Using Kansas National Guard members is also not an option. Major Gen. David Weishaar, the state’s adjutant general, said there were only 40 doctors and physician assistants in the guard’s ranks.
And fewer than five of them would be able to be mobilized, he said on a conference call Friday.
"We just don’t have a lot of national guard assets to distribute across the state," he said.
Instead, the guard and the Division of Emergency Management would focus on helping with patient transfers, mass testing and moving equipment across the state, Weishaar said.
State aims for ’air traffic control’ plan to free up beds
KDHE’s plan centers on moving patients from larger hospitals to smaller providers who have space once a person’s condition improved and they are less infectious.
This would be buttressed by what Norman termed to be an "air traffic control" system, or a database that allows hospitals to see where there are free beds.
And he said the state will also seek to deepen its relationship with LifeSave, a Wichita-based firm that transports patients by air and ground and which Norman said could also help find open space.
"We have a lot of beds in Kansas but they’re in the wrong place and they’re not critical care beds," he said. "What we’re working on very diligently ... is returning or repatriating the recovery patients so as to open up (beds). I have some degree of optimism that we can do that."
Hospital officials said it could work to ease some of the strain, especially given that COVID-19 patients tend to stay in the hospital longer, even as they recover and move out of an intensive care setting.
"Those patients that might need the higher level of care, it might improve access for them," Freelove said. "And you’re not doing anything to harm the patients who need a lower level of care. It could work, but at this point it is all what we can do to get through when things are bad."
Individual facilities are likely to continue to take their own actions. That could include shutting down out-patient departments to free up staffing or canceling elective procedures, although Stormont Vail has said they would avoid that at all costs.
"We're gonna do everything we can to continue to provide care to everyone who seeks it," Dishman said.
Mask mandate, Thanksgiving holiday to come
Then there’s Gov. Laura Kelly’s second attempt at a statewide mask mandate. While counties are still able to opt out of the order, she said it would purposefully take effect on Nov. 25 to allow local governments time to craft their own orders if they elect to do so.
It will be accompanied by a public service campaign urging mask-wearing, involving a series of prominent statewide groups.
The problem is that even if the push for mask wearing is successful, case counts won’t be affected until several weeks down the line.
"This is very quick to get worse and very slow to get better," said David Wild, vice president for performance improvement at the University of Kansas Health System.
And the Thanksgiving holiday looms large.
Some states are requiring those returning from other regions of the country for the holidays, or any other reason, to self-quarantine for a certain amount of time or have tested negative in the days before traveling.
Kansas is not doing that, although local and state health officials have echoed guidance from the Centers for Disease Control and Prevention urging residents to keep their gatherings small and socially distant.
The fear is that won’t happen. Following Canada’s Thanksgiving celebrations, which occur in early October, the two most populous provinces in the country set case records and most of the infections were tied to family gatherings.
A similar rise in the U.S. could leave hospitals with nowhere to go.
"If we screw up during Thanksgiving, and have a huge surge of cases, December is going to be bleak," Norman said